原发性肝细胞癌患者 TACE治疗前后血清血小板源性生长因子 -BB水平变化及其临床意义

目的　探讨原发性肝细胞癌（HCC）患者经皮肝动脉化疗栓塞（TACE）治疗前后血清血小板源性生长因子 （PDGF）-BB 的变化情况及其与近期疗效的关系。方法　选取2016 年1 月~2018 年10 月采用TACE 治疗的172 例 HCC 患者为观察组,另选取同期80 例健康体检者作为对照组,采用酶联免疫吸附试验法（ELISA）检测血清中PDGFBB 水平。结果　观察组患者术前、术后1 天、1 周和1 月的血清PDGF-BB 水平均显著高于对照组,差异均具有统计 学意义(P ＜ 0.01)。TACE 术前观察组患者的血清PDGF-BB 水平与肿瘤数目、肿瘤大小和有无癌栓相关(P ＜ 0.05)。 TACE 术后观察组患者的疗效与肿瘤数目、肿瘤大小、有无癌栓、术前血清AFP 水平和术后1 周血清PDGF-BB 水平显 著相关( 均P ＜ 0.05)。Logistic 多因素分析结果显示术后1 周血清PDGF-BB(OR=2.665, 95%CI: 1.231~5.769, P =0.000) 和肿瘤数目(OR=1.904, 95%CI: 1.023~3.544, P =0.005) 均是影响TACE 术后疗效的因素。结论　血清中PDGF-BB 水平与 TACE 术后HCC 患者的短期疗效密切相关。     

术前选择性经肝动脉化疗栓塞对肝癌患者手术治疗效果的影响

目的 探讨术前经肝动脉化疗栓塞术(TACE)对肝细胞肝癌(HCC)肝切除患者预后的影响.方法 回顾性分析130例HCC患者的临床资料,术前行选择性TACE(TACE组)65例,术前未行TACE(对照组)65例.比较术后1、2、3年复发率及生存率,评价可切除HCC术前行TACE的作用.结果 术后1、3年复发率两组无差异(P均＞0.05),术后2年复发率TACE组为30.8％,对照组为58.5％,TACE组的复发较对照组延迟(P＜0.01);3年生存率TACE组为53.8％,对照组为32.3％,TACE组的3年生存率较对照组明显提高(P＜0.05).结论 对可切除HCC,术前严格掌握条件行选择性TACE,可在一定程度上提高手术治疗的效果.     

肝动脉化疗栓塞、射频消融联合125I粒子植入序贯治疗不可切除原发性肝癌疗效观察

[目的]探讨肝动脉化疗栓塞(TACE)、射频消融(RFA)联合125I粒子植入序贯治疗不可切除的原发性肝细胞肝癌(HCC)的临床疗效.[方法]收集2014年3月至2016年2月收治20例不可切除HCC患者(共32个癌灶,病灶大小3～12 cm).所有癌灶先进行TACE,1周后在CT引导下进行RFA,再过1周后在CT引导下进行125I粒子植入治疗,1125I粒子植入采用术前TPS计划、术中CT引导下同轴法进行,粒子植入处方剂量(PD)为80～100 Gy,术后即时或1周内CT检查传入TPS验证粒子植入质量.随访观察患者临床症状、甲胎蛋白(AFP)、肝功能、影像学(肿瘤体积)等改变情况以及临床疗效、肿瘤复发情况和相关并发症.[结果]20例患者治疗后临床症状均有明显缓解;AFP均有明显下降,与治疗前比较差异有统计学意义(P＜0.05);ALT、TBIL、ALB均降低,但与术前比较差异无统计学意义(P＞0.05);影像检查见:肿瘤片状坏死、有不同程度的碘油沉积、肿瘤体积较治疗前明显缩小(P＜0.05),增强后无明显强化;125I粒子植入术后即时TPS验证结果:技术成功率为100％,即粒子植入质量很好,ID90 ＞MPD,1例CI=1,植入粒子剂量的不均匀度＜20％PD.随访时间3～24个月(平均12.7个月),全组肿瘤完全坏死率为93.75％(30/32),中位生存时间为11.2个月,半年和1年生存率分别为95％和75％.未出现严重并发症.[结论]TACE、RFA联合125I子植入序贯治疗不可手术切除HCC,近期疗效明显,有望成为不可手术切除原发性HCC更有效的新的治疗模式.     

原发性肝癌TACE治疗前后血清VEGF含量的变化

目的:研究肝细胞癌(HCC)患者经肝动脉灌注化疗栓塞术(TACE)后外周血血清中血管内皮生长因子(VEGF)的表达及其相关因素的探讨。方法:运用酶联免疫吸附测定法(ELISA)定量检测28例HCC患者TACE术前、术后即刻,术后1天、3天、5天、7天、14天、28天的血清VEGF的含量,并在术前及术后1天测定肝功和外周血血小板数量。结果:TACE术后1天血清VEGF升高达峰值,之后逐步下降,术后14天又开始升高。术后1天肝功(ALT和AST)升高达峰值,以后下降。术后1天较术前血清VEGF的变化与相应肝功变化,外周血血小板数量变化及术中碘化油用量无相关性。结论:TACE术后外周血VEGF含量的变化,反映了HCC患者TACE术后肿瘤组织缺氧及肿瘤血管生成状况,依据VEGF分泌规律,TACE术后选择合适时机进行抗肿瘤血管生成治疗,有望提高TACE的疗效。     

经导管肝动脉化疗栓塞治疗肝细胞癌前后磁共振灌注成像观察

目的 观察肝细胞癌(HCC)患者经导管动脉化疗栓塞(TACE)治疗前后磁共振灌注加权成像(MR PWI)灌注值改变.方法 对22例HCC患者在TACE术前和术后3～10天分别进行MR PWI,得出术前及术后平均强化时间(MTE)、负增强积分(NEI)、病灶达峰值时间(TTP)、最大信号下降斜率 (MSD),比较TACE术前与术后上述各指标的差异.结果 HCC瘤区时间信号曲线(TIC)TACE术前呈快速下降,TACE术后趋向平缓;MTE与TTP值术后较术前降低,NEI值术后较术前升高,差异均有统计学意义(P<0.05);MSD值术后较术前降低,但差异无统计学意义(P>0.05).结论 MR PWI能够敏感地观察到HCC TACE术前后的血流变化,可用于评价TACE疗效.     

CTA观察肿瘤滋养动脉变化对肝癌TACE术疗效评价的意义

目的探索CT血管成像技术（CTA）滋养动脉变化对原发性肝细胞癌（HCC）化疗栓塞术（TACE）疗效评价的意义.方法38例不能手术切除的HCC患者于术前1周内和接受2次TACE治疗4周后行螺旋CT增强扫描,并作3D图像重建,比较手术前后肿瘤滋养动脉变化,以消失、变细、无明显变化、增粗、出现新生血管分级,以改良RECIST标准评价肿瘤缓解程度.结果5例达到CR标准,肿瘤滋养动脉均消失;24例达到PR标准,超过半数的肿瘤滋养动脉消失或明显变细;9例达到SD标准,肿瘤滋养动脉无明显改变或部分变细.结论 CTA是评价TACE治疗HCC疗效的可行方法.     

肝细胞癌伴肝硬化门静脉高压患者肝切除术可行性研究

目的探讨肝细胞癌(hepatocellular carcinoma,HCC)伴肝硬化门静脉高压患者行肝切除术的可行性。方法对我院2009年1月—2013年3月收治的肝硬化HCC接受肝切除术512例的临床资料进行回顾性分析,根据术前是否存在门静脉高压将其分为门静脉高压组(143例)和无门静脉高压组(369例),观察比较两组一般资料、手术情况、术后死亡及并发症情况、随访期间生存率,并对两组生存状况、影响生存状况因素及死亡原因进行分析。结果门静脉高压组术前Child-Pugh B级、血清总胆红素20μmol/L、血白蛋白35 g/L及输血者所占比例均高于无门静脉高压组,而肿瘤直径≥5 cm者所占比例低于无门静脉高压组,差异均具有统计学意义(P0.05)。门静脉高压组手术时间、术中出血量、术后住院时间、术后病死率及并发症发生率均高于无门静脉高压组,差异均具有统计学意义(P0.05)。门静脉高压组随访期间生存率低于无门静脉高压组,两组比较差异有统计学意义(P0.05)。相关性分析显示,伴门静脉高压、甲胎蛋白20μg/L、肿瘤直径≥5 cm、肝切除范围1个肝段、术前无肝动脉化疗栓塞术(TACE)、组织学分化低、切缘0.5 cm、多发病灶肝硬化HCC患者生存率明显降低(P0.05)。利用Cox回归模型进行分析后得出肿瘤直径≥5 cm、多发病灶及术前无TACE是导致肝硬化HCC患者肝切除术后死亡的独立危险因子(P0.05)。结论门静脉高压并非影响肝硬化HCC肝切除术后生存的独立危险因子,HCC伴肝硬化门静脉高压患者可行肝切除术,肝脏功能保护为肝切除术后重要环节。     

肝癌肝动脉化疗栓塞术前、术后血清AFP数值变化

目的　评估原发性肝细胞癌(HCC)患者血清AFP数值变化在介入临床治疗过程中的意义。方法　136例Child PughA级HCC患者,均经导管化疗栓塞(TAC/TACE)干预。按照栓塞剂用量进行分组;分别于术前3天、术后3天、以及术后4～6周进行血样采集;采用放免方法对样本血样进行血清AFP数值测定。结果　Child PughAgroupHCC患者按照碘油用量分组,术后4～6周AFP数值与术前3天相比无显著性差异(P >0. 0 5 )。术后3天AFP数值与术前3天相比,AFP数值变化存在显著差异,其中TACE(I.O≥8ml)组差异性显著(P <0 . 0 5 )。非规律TACE组与规律TACE组2次治疗术前AFP数值相比较,具有统计学显著相关性(P <0 . 0 0 5 )。结论　在允许的情况下,适当增加的碘油的用量、规律进行TACE治疗可以更好的降低血清AFP数值,达到介入治疗控制HCC的目的。     

经导管动脉化疗栓塞术后甲胎蛋白变化对肝癌患者预后的预测价值

目的:分析肝细胞癌(HCC)患者经导管动脉化疗栓塞术(TACE)术前后甲胎蛋白(AFP)的变化,来预测肿瘤的变化和患者的生存期.方法:评估自2005年1月至2007年12月在复旦大学附属中山医院肝癌研究所接受T ACE治疗的HCC患者的资料.根据患者TACE术前及术后1个月AFP浓度的变化,把患者分成3组:明显下降组、...     

介入治疗联合适形放射治疗原发性肝细胞癌的疗效分析

目的：探讨经导管肝动脉灌注化疗栓塞（TACE）与TACE联合三维适形放射治疗（TACE＋3DCRT）原发性肝细胞癌（HCC）的疗效。方法：随机分成两组的HCC患者,均不能手术、门脉无癌栓、无远处脏器转移。50例患者行单纯TACE2次（TACE组）。40例患者在TACE2次后第四周再行三维适形放射治疗（TACE＋3DCRT组）,放疗采用6MV-X射线,4～6Gy／次,隔日一次,3次／周,总剂量45～60Gy。TACE采用碘化油、顺铂、5-氟尿嘧啶、表阿霉素及明胶海绵。结果：TACE组与TACE＋3DCRT组近期疗效有效率（完全缓解＋部分缓解）分别为68．0％（34／50）、87．5％（35／40）,1年生存率分别为78．0％（39／50）、95．0％（38／40）,两组差异均有统计学意义（P〈0．05）。TACE的治疗反应主要为栓塞综合征,3DCRT有7．5％（3／40）发生急性放射性肝炎,经对症、保肝处理后缓解。两组患者均能耐受。结论：TACE＋3DCRT治疗不能手术、门脉无癌栓、无远处脏器转移的HCC的疗效较单纯TACE治疗HCC的疗效好。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。